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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />f <br />ANNUAL FEE and REPORT REQUEST <br />Colorado Quarries, Inc. ¢'V- <br />i1VI-1992-058 <br />Mica White <br />August 5, 2005 <br />~c~o <br />~:T ~ 3 2CJ5 <br />$281.00 (Due on or before your anniversary date) <br />Fremont <br />~~~ ~~ bS <br />Q~ -, <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />oUerator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and dunng t e prece mg year, new disturbances that-are-anticipated-t~ <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. Please note that an <br />adequately labeded map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: 13111 Tezak <br />Permittee Name: Colorado Quarries, Inc. <br />Address: 270 S. 15th St. <br />Canon City, CO 81212 <br />Phone Number: (719) 275-6894 <br />Fax Number: (719) 275-2131 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />ignatur of Co orate O i~ caner ~ ~ ` <br />~J 1t" <br />Date <br />